Provider Demographics
NPI:1063730760
Name:JONES, EDDIE V
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:V
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1539
Mailing Address - Country:US
Mailing Address - Phone:989-672-6160
Mailing Address - Fax:989-672-5649
Practice Address - Street 1:467 N STATE ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1539
Practice Address - Country:US
Practice Address - Phone:989-673-5700
Practice Address - Fax:989-672-2017
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089876104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI20593OtherBCBS SUBSTANCE ABUSE
MI7509107420OtherBCBS
MI0G96288Medicare UPIN
MI20593OtherBCBS SUBSTANCE ABUSE